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A Delegated-Risk Model for Driving Down Cardiovascular Care Costs and Improving Quality

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CASE STUDY newcenturyhealth.com A Delegated-Risk Model for Driving Down Cardiovascular Care Costs and Improving Quality New Century Health leverages a specialist network to reduce inappropriate procedures and achieve savings for a Medicare Advantage plan. © 2019 New Century Health • NCH-1911749-0603 THE SOLUTION New Century Health (NCH) agreed to: • Accept fully delegated clinical and financial risk for the plan's cardiac patients under a capitated arrangement. • Contract cardiologists through an aligned value-based payment model to provide care at 11 primary care clinics owned by the plan. • Deliver comprehensive services at the clinics and affiliated hospitals, including clinical cardiology, onsite diagnostic testing, cardiovascular interventions, electrophysiology and surgery. • Prospectively approve, through a clinical decision support platform, procedures performed by cardiologists and provide evidence-based guidance to the primary care physicians ordering cardiac screening diagnostics and services. WHY OUR APPROACH WORKS • Clinical review, including Medicare coverage determinations and American College of Cardiology Appropriate Use Criteria, reduces overutilization and leads to treatments with the highest patient benefit-to-risk ratios. • Value-based payment models correct provider-payer misalignments common in fee-for-service. • NCH builds high-performing specialty physician networks— in this case by embedding its contracted cardiologists within the plan-owned primary care clinics. In the first year of this partnership the plan realized more that $5 million in savings and experienced: THE RESULTS $7.81 Part A Savings Across 80 Diagnostic Related Groupings PMPM 23% Reduction in Part B Utilization Run Rate $6.77 Part B Savings PMPM THE CHALLENGE The client needed to deliver coordinated, high-quality cardiovascular care to 32,000 Medicare Advantage members assigned to its wholly owned, multispecialty provider network. However, managing cardiac care costs had become increasingly difficult in the client's fee-for-service provider reimbursement environment. Lacking a comprehensive clinical review process, physicians frequently ordered cardiac procedures that were inappropriate, exposing patients to additional risks and increasing the cost of care.

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